A 34-day-old girl was admitted to department of pulmonology because of fever from day 28. The peek body temperature was 37.6 to 37.7°C. She was born to a Chinese 25-year-old G1P0 at 37 weeks 4 days’ gestation (3300 g birth weight without resuscitation). Her mother had visited and stayed for several periods in her own parents’ house, where also once kept 20 sheep. Although she had never fed or touched those sheep, the mother had fatigue and arthralgia for 2 weeks, fever and membrane rupture 1 day before the baby was born. Considering the mother might have been experiencing chorioamnionitis, which was later confirmed by pathology, the baby was delivered by Cesarean section. The baby was fed mother’s milk only for 4 days until the mother’s blood culture revealed a positive result of brucellosis. The mother immediately started 6 weeks’ course of rifampicin and doxycycline. A screening of Rose Bengal plate test among her family showed that the mother’s father was also positive and symptomatic while other family members were negative. The grandfather had fatigue, arthralgia and low grade fever for 4 months without seeking medical help. He had killed and sold out all the sheep because of his fatigue and arthralgia before the baby was born.
The baby’s father took her to the pediatric department at another hospital on the 3rd day of fever, where acute upper respiratory tract infection was diagnosed and she was observed for one night. Blood samples were obtained for blood culture and Rose Bengal plate test. The baby’s body temperature turned to normal since the second day. So she was discharged. However, fever came back again after 3 days of normal body temperature. This time, she was agitated and easy to cry. She had a peak body temperature of 37.7°C, once a day. Her father immediately took her to our hospital. She was admitted into department of pulmonology after only a short lingering in outpatient clinic without doing laboratory test or therapy. On physical examination, the girl was febrile (37.6°C), with heart rate 144 beats per minute, respiratory rate 34/min, blood pressure 74/43 mm Hg. She appeared acutely ill but nontoxic. Her oral mucosa was normal. Her lungs were clear in auscultation. Her abdomen was not distended. Liver and spleen was not palpated below the costal margin. Her joints were all normal. Findings of neurologic and dermatologic examinations were normal.
On the second day, the girl still had fever. The highest body temperature was 38.2°C. Moreover, she seemed lethargy. Bacterial meningitis was suspected and lumber puncture was done. The cerebrospinal fluid (CSF) contained 85 leukocytes per microliter (86% mononuclear cells), with a protein level of 102.6 milligram per deciliter and a glucose level of 40 milligram per deciliter. The local hospital reported us positive blood culture with Brucella meliteusis and positive Rose Bengal plate test. Culture of two samples of blood and one sample of CSF also showed positive with Brucella meliteusis. The diagnosis of brucellosis and Brucella meliteusis meningitis were established with hyperbilirubinemia and liver dysfunction. For sulfamethoxazole/trimethiprim (SMZ/TMP) is forbidden to used in children < 2 months, we stared treatment of rifampicin (6 weeks) and meropenem (2 weeks). Her body temperature turned to normal within two days of treatment but reoccurred 3 weeks after discontinuing rifampicin. Laboratory test including positive blood culture with Brucella meliteusis, positive Rose Bengal plate test, and > 1:400 in serum agglutination test (SAT) of brucellosis all suggested relapse of brucellosis. This time, her liver function was also affected. A combination therapy of rifampicin and SMZ/TMP was started immediately. Body temperature turned to normal on the third day. This time the therapy lasted for eight weeks. She was normal after one month of weaning the therapy. The baby was still in following-up. Later Brucella meliteusis DNA detected by next-generation sequencing and bacterial identifying under microscope (Fig. 1) in mother’s placental wax specimen suggested this is a congenital brucellosis case.